New Solutions for Old Therapies

Recovery options used by the pros

Several years ago, Alberto Salazar told me about a time he'd had an injury that was affecting his foot, keeping him from running. So, he had a special orthotic made that shifted footstrike forces enough for him to do at least a modicum of training. Every week or two, he replaced the orthotic with a new one, ramping his training back up, orthotic by orthotic.

More recently, 2008 Olympic marathoner Dathan Ritzenhein had his own foot injury. While the injury healed, Salazar, now Ritzenhein's coach, had him train on an AlterG treadmill, a device that uses an inflatable ring, somewhat like a truck-tire inner tube, to lift as much as 80 percent of his body weight off his feet. It's a bit like pool running, without the chlorine.

Both are examples of what money-is-no-object injury rehab can get you. (There are two AlterG models, priced at $24,000 and $75,000.) What else is on the cutting edge, trickling down from the training rooms of well-heeled pros to the average Jock and Jill? Here are a few of the space-age gadgets elites are turning to.

Game On?

The Game Ready cold-therapy unit (illustrated above), made by CoolSystems, Inc., is a simple device in principle: basically an ice chest with a pump that circulates cold water through a cuff shaped to fit your injured body part. But its control unit has some pricey technology ($2,350 online) that sets the pressure in the pad, monitors the water temperature, and times its application. Luckily for those on a budget, there are other brands of cold-therapy machines that dispense with the fancy control unit and cost between $100 and $300. Without timers or temperature monitors, they're either "on" or "off ," and you pick your desired level of compression by feel, with Velcro straps.

Brad Aiken, medical director for rehabilitation at Baptist Hospital in Miami, calls the Game Ready a great example of how many of these "new" devices more build on than revolutionize traditional therapies: In the case of Game Ready, it's basically a combination of cold and compression, both of which are long-used treatments for acute injuries. "It's using new technology to get a bit more application of the cold or the pressure in the right area," he says. "But it's the cold and pressure that really work."

While the Game Ready and its kin were designed for surgical patients, that's not their only use. "It makes sense that it would be helpful for a joint that is swollen and inflamed," says sports-medicine orthopedist Robert Sandmeier of Portland, Ore. CoolSystems' Web site lists several pro football players among its owners.

Runners will be tempted to also use such units for speeding recovery from hard workouts, but that might not be a good idea. "I am not sure it would be helpful for an uninjured body that is [merely] overworked," Sandmeier says. "For that, I would think things to promote muscle relaxation and improve circulation would be best. Ice generally is used to do the opposite in order to decrease swelling."

The Game Ready is a prescription device, so you can't just buy it off the shelf. Cheaper cold-therapy units, however, are readily available online. And if you do want to go top-of-the-line, the prescription shouldn't really be an obstacle if you've got a swollen knee or pulled hamstring pleading for attention.

Strap it On

Taping is another old technology, but tape is constantly evolving as manufacturers develop ever-more-sophisticated materials. One of these is Kinesio tape, an elasticized material that, depending on how it's applied, can either help you move, or restrict you.

If you watch any kind of professional sports, you've seen it in action. It's that gaily colored stuff athletes put on their calves, quads, knees, elbows, shoulders -- whatever's ailing them -- to help them do their thing despite an injury or weakness. A 103-foot roll of Kinesio tape costs around $65.

"A lot of guys on the Tour [de France] had it," says Bob Schwartz, a cyclist and rehabilitation doctor at St. Luke's Rehabilitation Institute in Spokane, Wash. "There were two with broken wrists, and they kept riding with the tape on. Whether that helped, I don't know, but they had it on."

"Since the [Beijing] Olympics, it's gotten a lot of air time," adds Steve Hanson, a runner and sports medicine chiropractor in Beaverton, Ore., who assisted at the 2008 Olympic track and field trials.

Meb Keflezighi (illustrated, right) won the 2009 New York City Marathon with Kinesio tape around his left knee. Molly Huddle, whose 14:51 5,000m PR makes her the fourth fastest American ever, also uses it. Her chiropractor often applies it to promote circulation after Graston or other treatments. In addition, notes Huddle, "I've also worn it during a race or training, for areas that are sort of injured and 'not firing.' In college, I wore it on a weak/strained hip flexor during races."

Nobody's sure how it works. One obvious aspect is its extremely high elasticity. "It doesn't alter your range of motion too much," says Hanson. "It just gives you a little extra pull in whatever direction you decide will help out."

In addition, he says, ripples in the tape surface appear to produce a "micro-massage" effect. "That, to an extent, helps pump blood." The tape may also send signals to the brain via the body's proprioceptors -- the internal sensors that tell you the position and movement of your limbs even when you're too busy suffering (or ogling the runner ahead of you) to be consciously thinking about running. "Every time you move, you're going to get some impulse to the brain," Hanson says. "You're going to feel it tugging and pulling. So, a bit of it may be a muscle-memory thing."

Huddle agrees. "I don't really notice an effect in healing, but it does make you more aware of the muscle," she says.

The pros often have professional trainers who tape them up whenever they need it. But that's not required. Many tape jobs can be taught to you by a practitioner, Hanson says. "The tough job is learning how much tension you [need] and the placement of the tape."
Speed of Recovery

Injury rehab isn't the only thing runners are interested in. It would also be nice to speed up recovery periods between hard workouts. After all, the more often you have to delay a hard tempo run or track workout because you're not quite recovered from the previous one, the fewer key workouts you can do. "Over the course of a month you [might] miss two or three workouts you could have had," Canadian triathlete and two-time Olympic medalist Simon Whitfield told the Discovery channel in 2009.

Training, nutrition and recovery are the big three determinants of performance, says Gilad Jacobs, vice-president of athlete technologies at NormaTec Sports, which makes an inflatable recovery "boot" that Whitfield uses in his quest to minimize his between workout down time.

Training and nutrition have long been explored by coaches and athletes. It's recovery that's the vast, unexplored country. "Everyone is running in the same gear," Jacobs says. "Everybody is eating more or less the same thing, putting in the same miles. Recovery is coming up as the number one difference-maker."

Coaches have long had runners jump into ice baths after hard workouts. But despite anecdotal reports that this works, there's surprisingly little scientific evidence. Opponents argue that icing should be limited to injury treatment. For normal training aches, they say, you have the same problem that Sandmeier sees with higher-tech versions of icing like the Game Ready: There's no swelling to reduce and icing merely causes arteries to contract, pinching off blood flow.

Whichever side of this debate is correct, ice is undoubtedly uncomfortable. It's also time-consuming and carries some risks. (Mild hypothermia is quite possible if you stay in too long.) An alternative is compression, ideally in the form of athletic clothing.

Compression clothes have been around for a long time.

"In the 1980s," says Rey Corpuz, director of marketing for McDavid Sports Medicine in Woodridge, Ill., "there was a story from the days of Thurman Thomas [a running back for the Buffalo Bills]. He was having trouble with his hamstrings, so he bought a woman's girdle for his thighs. That was the start of compression."

Since then, compression garments have become all the rage in cycling and triathlon, equipment-heavy sports that are often ahead of running on the technology bandwagon. "A big thing in cycling right now [is] form-fitting garments with gradients in compression moving up the leg," says Schwartz. "The theory is that they are tighter distally [farther from the heart] because you don't want the fluids getting trapped down at your toes. Then, a gradient in pressure moving up the leg helps pump fluid back up. Some [racers] wear them during cycling, and some put them on right after the race."

Elite runners are learning the same thing. Olympic marathon medalist Deena Kastor uses ASICS' Inner Muscle line of compression tights and capri pants for many of her workouts. "[It] is a combination of fabrics of different elasticity and seam lines, so your hips, glutes, and legs are being assisted with proper running mechanics," she says. "For me, the difference feels as if the material in the tights is pulling down on my lower back and pushing my hips under me. With this subtle correction, I am getting more power from my hips and less from overworking Achilles and feet. It helps me with a more efficient stride."

Useful as these garments are, however, a few years ago Corpuz thought it might also be beneficial to have ones designed solely for recovery -- especially if they were comfortable enough to be worn on the plane, flying home from a Sunday marathon, or sitting on the deck with the family after a hard track workout.

The product is now on the market: tights and shirts ($75 each) designed not for running, but for vegging out.

"From the feet up, [the tights] apply enough pressure to force the [old] blood out," Corpuz says. Then, with the old blood stopped from pooling in the extremities, "what your body naturally does is to push fresh blood in."

The tights, which I tested for this article, felt like tighter-than-average running or cycling tights, but with a better-than-average range of motion. "[That's because] we relax the area around the knees and groin so you can sit for long periods of time without feeling that this thing is going to squeeze the life out of you," Corpuz says.

Huddle uses something similar from Saucony. "I have worn them all day after a workout, or to bed," she says. "They are quite comfortable."

These Boots Aren't Made for Walking

Higher tech, and a bit less portable, are NormaTec's "boots," officially known as the MVP, for Most Valuable Pump (illustrated, above).

The professional version, used primarily by cyclists, triathletes and basketball teams, costs $4,850 and is the descendent of hospital equipment designed for patients with poor circulation.

It's not something you can run in. Or even walk. Imagine hip-waders, connected to an air pump and a control box about the size of a toaster. The pump cycles air through five chambers that compress in rhythm to move venous blood and lymphatic fluid from the foot to the calf, then to the knee, etc., until it's squeezed all the way out of the leg. "Think of big blood pressure cuffs," says Jacobs.

The cuffs don't just force spent blood and lymphatic fluids heartwards. They also relax in the right sequence to allow fresh, arterial blood to rush back. "The machine is your masseuse," company representative Jacobs says. Nike believes in it enough that Salazar overnighted a NormaTec sleeve to Switzerland in the summer of 2009 after Chris Solinsky rolled his ankle on a training run.

And while the price tag is high enough to keep most recreational runners at bay, that may soon change: The company is hoping to have a consumer version on the market by Christmas or early 2011, priced at about $1,500. The primary difference is that the pumping cycle -- programmable in the professional version -- will be standardized, simplifying the control box.

Meanwhile, Olympic marathoner Ryan Hall loves his pro version, particularly after travel. "Some [athletes] have even been known to sleep with them to get through injuries and such," he says.

Kastor is also a fan. "This is the single best recovery device, post-workout," she says. "I am married to a massage therapist, and still find it challenging to get work done every day. The NormaTec device, or 'my legs,' as I call it, is a great way to recover between workouts."

Expensive Fun, or the Real Thing?

Do these devices work?

At the most basic levels, the answer is as old as sports medicine. "A lot of the new stuff is [also] the old stuff ," says Brad Aiken, M.D. "There's always stuff coming in and out of vogue -- something 'new' that's basically a repackaged version of something that's been around before."

"There are a lot of gadgets out there," Hendrick Ramaala, winner of the 2004 New York City Marathon, notes. "I still use the old-fashioned way of deep sports massage and stretching. I guess I haven't moved with the times yet."

South African exercise physiologist Timothy Noakes, author of Lore of Running, is another skeptic. "I suspect that a lot of this is hype," he says. Furthermore he's cautious in general, about any effort to promote excessively rapid injury recovery. "We know, for example, that muscles probably take two to three months to fully recover," he says. "If you return to activity before then, you only put yourself at risk of another injury."

Sped-up recovery from training workouts, however, might be a different matter. NormaTec Sports' Gilad Jacobs says that there is scientific evidence (as yet unpublished) that his company's boots work. The study used a device called an algometer to measure how hard you can press on a muscle, such as a quad, before a person feels pain. Testing before and after use of the boots, Jacobs says, has shown that the boot reduces muscles' sensitivity, both immediately and hours later -- a sign that they're recovering. There might be a reason why Hall, Kastor and others are such enthusiastic fans.

Other technologies, such as Kinesio tape and compression tights, are inexpensive enough that they might fall into the try-it-and-find-out arena. Just don't expect miracles. "It helped a little," Huddle says of her collegiate use of Kinesio tape. She's equally cautious not to overhype compression clothing. "Any results are too subtle to notice right away," she says. "But if it helps even a small amount, I figure it is worth wearing them."

Ultimately, what matters might be what you yourself think is best. That sounds trite, but if you don't believe in a method, it might well not work, even if everyone else says it does. Studies have found, for example, that if you give people sugar pills and tell them they might be harmful, you may indeed see the suggested side effects. (This is called the nocebo effect: the opposite of placebo.) Conversely, if you pick the recovery or rehabilitation method you most believe in, it might give you better results than methods others try to pick for you. Even in surgery, Aiken says, "a lot of the results are often because of the hands-on effect of the [physical] therapist."

Perhaps that, more than anything else, is the secret of the pros. The best often have people -- and treatments (high-tech or low-tech) -- that they believe in.

RICHARD A. LOVETT is a freelance writer, running coach and masters runner based in Portland, Ore.